Primary care physicians within the Veterans Health Administration will begin asking their patients this week whether they think they were exposed to environmental hazards during their service -- a conversation Department of Veterans Affairs officials say should lead to increased awareness and treatment for medical conditions linked to burn pits, pesticides, industrial chemicals and other toxins vets encountered in the military.
But advocates for military personnel and veterans say the five-minute screening doesn't go far enough and are pressing the VA for medical screenings, including cancer tests, for those who served in geographic areas with the most likelihood for exposure.
During a demonstration of the new screening process, VA Press Secretary Terrence Hayes, a retired Army master sergeant, answered questions from a physician on possible exposure, noting that during his time in Iraq he was potentially exposed to burn pits but had no symptoms.
He was provided a folder containing information on toxic exposures and related illnesses; related benefits; and the burn pit registry, a voluntary database kept by the VA of veterans who served in the Persian Gulf War and onward who may have been exposed.
As part of the three-question screening, Hayes was asked whether he had any health concerns he thought might be related to exposure.
"Can't kinda put my finger on it. There were some things I dealt with in the past that I think I've gotten worked out, but nothing I can really put my finger on," Hayes said during the screening at the Washington, D.C., Veterans Affairs Medical Center.
Screening physician Dr. Joel Nations, the hospital's deputy chief of staff for operations, told Hayes his answers to the questions will be placed in his medical record and he again will be asked about any symptoms or concerns in five years.
The screenings are now required at VHA facilities as part of the Promise to Address Comprehensive Toxins, or PACT, Act, which was signed into law by President Joe Biden earlier this year after veterans groups protested delays in Congress that held up the legislation.
Advocates say the process doesn't go far enough to educate veterans on exposures, arguing that vets may not realize they have been exposed to toxic substances.
Chelsey Simoni, a clinical nurse researcher with the HunterSeven Foundation, a group established to support personnel with military exposure-related illnesses, said the VA isn't drilling down to geographic areas where service members were known to have exposures and their physicians are not well-versed on the extent of the hazardous environment.
Simoni said that, when she was young, she had no idea that her activities, such as exercising in a combat zone, would lead to bronchial infections, a weakened immune system and lung nodules.
"The three questions we are asking are not OK. They do not do justice," Simoni wrote in an email to Military.com.
She also noted that, since the questions are being asked only within the VA health care system, the department is missing roughly 70% of the post-9/11 veteran population who don't receive their care in a VA facility.
"As a civilian provider, I can tell you we are less than 4% competent to provide veteran-centric care and are more likely to identify a post-9/11 veteran's symptoms as psychosomatic rather than health-related," Simoni said.
Hayes said the standard screening questions may appear to be basic, but the discussion they spark could lead to medical testing and follow-on care with a specialist. If he had said, for example, that he had asthma, he might be referred for an appointment and told that the condition is considered to be linked to burn pit exposure and he could be eligible for disability benefits.
"The standard screen, it could be five minutes. It could be 15, 20 minutes. It depends on the conversation between the doc and the veteran, where that leads to -- follow-on testing and treatment," Hayes said.
The PACT Act contained a number of provisions to assist the estimated 3.5 million veterans at risk for illness as a result of exposure to burn pits, airborne particulate matter, chemicals and other toxic substances encountered during overseas deployments. The law broadened health care services and disability compensation to an estimated 1 million veterans, and it established a pathway for expedited disability compensation for vets stricken with certain diseases.
VA officials are pressing eligible veterans not enrolled in VA health care to do so and hope the exposure screening and subsequent tracking of medical conditions will act as incentive.
"This is why we want people to enroll. We want them all," Hayes said.
Veterans can call to make an appointment with their primary care providers specifically to take the screening or they will be quizzed at their next appointment beginning Nov. 8.
Those who want more information on the PACT Act or to apply for disability benefits should go to the VA's website or call 1-800-MY-VA-411 (1-800-698-2411).
-- Patricia Kime can be reached at Patricia.Kime@Military.com. Follow her on Twitter at @patriciakime.